The Sensitivity and Specificity of Cognitive Screening Instruments to Detect Cognitive Impairment in Older Adults With Severe Psychiatric Illness

Abstract

Background Older adults with severe psychiatric illness are often treated at community mental health centers (CMHCs) and these individuals commonly have numerous risk factors for cognitive impairment (CI). Brief cognitive screening instruments are frequently used to evaluate cognitive functioning in CMHCs, but the validity of these measures for detecting CI has not been adequately evaluated in this patient population. Objectives To determine the sensitivity and specificity of 2 cognitive screening measures (the Mini-Mental Status Examination [MMSE] and the Stroop Color and Word Test [SCWT]) for detecting CI in a sample of older adults with severe psychiatric illness. Methods Data were collected from 52 older adults receiving services at a CMHC. Diagnosis of CI was made by a neuropsychologist. Sensitivity and specificity coefficients for 2 cutoff scores for the MMSE and the SCWT were calculated. Results A cutoff score of 25 on the MMSE yielded a sensitivity of 43.3% and a specificity of 90.4% for detecting CI, whereas a cutoff score of 21 yielded sensitivity of 13.1% and 100% specificity. Using an age- and education-corrected scaled score (SS) on the SCWT falling at or below 7 as the criterion the SCWT had 88.8% sensitivity and 36.8% specificity, whereas a cutoff score of 5 or below yielded sensitivity of 59.2% and specificity of 57.8%. Conclusions Overall, the MMSE was found to be the more clinically useful cognitive screening tool for use in CMHC. Yet, because of the poor sensitivity of the MMSE for detecting CI in this patient population, alternative screening methods should be explored.

Rates of formal diagnosis of dementia in primary care: The effect of screening

“…Some of these patients might have been misdiagnosed. Because previous studies showed that the MMSE is less sensitive for detecting milder forms of cognitive impairment (43%–43%) [36] than the DemTect (80%–100%) [19], [37], the rate of false-positive diagnoses in our study might have been lower than 24%. However, we were unable to validate the GP diagnoses with our data.…”

Aging, Cognitive Decline and Hearing Loss: Effects of Auditory Rehabilitation and Training with Hearing Aids and Cochlear Implants on Cognitive Function and Depression among Older Adults

“…The Stroop test is a measure of reaction time and investigates executive function and selective attention [Mackin et al, 2010;Seo et al, 2008;Rivera et al, 2015] The MoCA is a cognitive function screening test of various cognitive domains and was included as it has been shown to have 90% sensitivity and 87% specificity that enables identification of 90% of cases with mild cognitive impairment (MCI) and 100% of patients with mild Alzheimer disease. A score of 26/30 and higher on the MoCA is considered normal, and results are corrected with coefficients for different levels of education [Nasreddine et al, 2005].…”

Why Almost Always <b><i>Animals</i></b>? Ranking Fluency Tasks for the Detection of Dementia Based on Receiver Operating Characteristic (ROC) and Quality ROC Analyses

“…Previous studies have included sensitivity and specificity as descriptive measures in their clinical research on cognitive impairment [e.g., [28]]; however, to our knowledge, only Monsch et al [7,8] analysed fluency tasks as diagnostic tests using the ROC approach. These authors make descriptive use of the AUC, sensitivity, specificity, and OCP of both a category fluency task (collapsing the categories animals , fruits , and vegetables ) and a letter fluency task (collapsing F , A , and S ).…”

“…Sensitivity is the probability of correct detection of a diseased subject, while specificity is the probability of correct rejection of a healthy control. In less formal words, sensitivity is the power of a test to detect a diseased patient, and specificity is the power to reject a control, non-diseased subject [e.g., [28]]. Thus, every score obtained from our participants in a category fluency task could be considered a provisional cut-off point below which a patient could be diagnosed as diseased and above which a patient could be diagnosed as non-diseased.…”

“…Finally, when we are interested in both the sensitivity and the specificity of a task, there is a special score in a fluency task that maximizes the 2 indices at the same time. The so-called optimal cut-off point (OCP) [26] is the point on the ROC function where the fluency task achieves its maximal quality of efficiency (QEF) k(0.5,0) as a discriminant tool [e.g., [8]; for other cut-off points in screening, see [28]]. As much as the set of different cut-off points in a fluency task gives rise to a set of tests (known as the “test family,” as proposed by Kraemer [26]) about the same psychological or clinical construct (test base), the OCP provides us with the referent test of the family [26].…”